In the last six years, the Council has been working on a code modernization project. Modernizing the Code has highlighted gaps in the current Code and illuminated policies that can be withdrawn because they are no longer applicable to the contemporary practice of medicine. The proffered Code modernization can be viewed by AMA members, and once finalized will be viewable by the public via the AMA website. The new Code will be composed of 12 chapters and is streamlined and efficient.

Case Resolution

Let’s return to our case. First, we will use our moral compass. Arguments to use the patient to order the prophylaxis are: 1) the patient will not pay for the medication out of pocket; 2) you won’t need to mess up the workflow of the ED; and 3) this is the easiest way you can think of to get the prophylaxis. Reasons against would be: 1) it is now putting a medication on the patient’s chart that was not received and may confuse future treatment decisions; 2) Medicare is being charged for a medication that was not given to the patient, and this may be considered fraud; and 3) you have an alternative way of getting the prophylaxis via paperwork and some additional time.

Principle III states, “A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.”

Now, let’s see what the Code has to say on this matter. Principle II of the Code states, “A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.” Principle III states, “A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.”²

It does appear quite clear. The ethical choice is to go through the hassle of the paperwork and have the medication ordered under your name and recorded for the appropriate use (postexposure prophylaxis).

I encourage you to familiarize yourself with the principles of the AMA Code of Medical Ethics and to use the Code to practically apply ethical principles to your current practice.

If you would like to get more involved in the AMA and setting ethical policy for our profession, please contact Dr. Fairbrother at Hilary.Fairbrother@nyumc.org.